What’s really keeping you awake

You know you have insomnia when it takes longer than 30 minutes to fall asleep, or if you wake up multiple times a night and toss and turn for a half hour or more, at least three times a week for a month. But it's rarely just insomnia: In 75 percent of cases, another health concern is at play. Tackle the source, and the sandman will follow.

Restless legs syndrome

Symptoms of this neurological disorder include creepy-crawly leg sensations and an uncontrollable urge to move legs. They worsen at night, and moving the legs relieves them temporarily.

What it feels like Every day, often right before she goes to bed, Katy Doench feels the weird tickly feeling in her thighs and toes that has bugged her since she was a child. “I feel as if I have to stretch my muscles, but I can’t stretch them far enough to make the weirdness go away,” explains the 31-year-old professional quilter in Cincinnati. “Walking up and down the stairs sometimes eases the sensations long enough for me to get to sleep. But there are times when they wake me up every hour all night long.”

How to fix it Little is known about what causes RLS, but experts believe iron deficiencies and some drugs such as antihistamines can trigger it. Massages, hot baths and regular exercise offer relief to those with mild cases. Drugs, including anticonvulsants and dopamine agonists (also used for Parkinson’s disease), are useful in treating more severe cases. Although Doench won’t take meds—she worries about side effects—she has found some respite by taking iron supplements and avoiding antihistamines.

Anxiety

A state of nervousness and tension, it can come with irritability, dizziness, sweating and difficulty concentrating and making decisions. Anxious thoughts can also keep you up nights or wake you up midsleep.

What it feels like “I worry a lot,” admits Aimée White, a 27-year-old customer service rep in Riverton, Utah. “About what others around me think, about people judging me.” Unfortunately, she occasionally takes her angst to bed with her and awakes before sunrise, her heart racing or tears streaming down her face. “There are times I can calm myself down,” she says. “But other times, I can’t, and I’ll have severe anxiety all day.”

How to fix it “Almost all anxiety and mood disorders are connected to insomnia,” says John Winkelman, M.D., medical director of the Sleep Health Center at Brigham and Women’s Hospital in Boston. These disorders disrupt sleep cycles, though experts don’t fully know why. White eventually sought treatment and was prescribed Zoloft for her anxiety. She also does yoga and posts positive affirmations around her house. Now early-morning panic attacks happen only a few times a year. If you suffer from anxiety, the American Psychological Association can help you find a therapist.

Sleep-related eating disorder

Sleep eaters get up in the middle of the night and chow down—without waking. Often, the only clue to their munching comes the next morning in the form of crumbs.

What it feels like While Alison Perrine, 35, was pregnant six years ago, she developed an odd habit. “I would go to the kitchen in the middle of the night and eat anything I could get my hands on, even things I don’t normally eat, like pasta salad with mayo—which I hate,” says the marketing coordinator from Branchburg, New Jersey. She blamed pregnancy hunger, but the habit didn’t go away after her baby was born.

How to fix it Experts suspect that the hormones and circadian rhythms which regulate hunger and sleep are misaligned in sleep eaters. Treatment can involve behavioral approaches (not having food in the house) and drugs (Zoloft). Perrine takes Clozapine, an antipsychotic, and sleep-eats less often.

Sleep apnea

Snoring and fatigue are major signs of this breathing disorder. It occurs when the muscles and soft tissue in the throat relax, blocking airways. When blood oxygen levels dip too low, the brain wakes you up (cue snoring) to restore normal breathing.

What it feels like For as long as she can remember, Jenny Stamos Kovacs, 31, has needed 10 hours of sleep a night. “By late afternoon, I wanted desperately to sleep,” says the writer from Kitchener, Ontario. Then six years ago a boyfriend mentioned the little snorting noises she made while sleeping. “No one had ever told me I snored!” Kovacs says. A few visits with a sleep doctor and a night in a sleep clinic soon proved her snorting was due to sleep apnea.

How to fix it Not all snoring is a sign of trouble, but if you suspect you have apnea, see a specialist: Left unchecked, the disruptions in oxygen flow can lead to stroke or heart disease, warns Lisa Shives, M.D., medical director of Northshore Sleep Medicine in Evanston, Illinois. Sleeping on your side and avoiding alcohol (which relaxes tissues in the throat) can help ease mild apnea. More severe cases call for a continuous positive airway pressure machine, which involves wearing a mask that sends a steady stream of air into your nose or mouth. Kovacs now sleeps with a CPAP machine and reports needing fewer naps.

Narcolepsy

Sufferers have “sleep attacks,” in which they suddenly fall asleep or experience cataplexy, a loss in muscle tone that causes the neck to go slack or knees to buckle.

What it feels like Amy Baker, 29, a stay-at-home mom in Indianapolis, first crumpled to the floor, asleep, four years ago, while holding her infant son. The baby was fine, but she broke her left arm. Three weeks later, she fell asleep while standing again and broke her right arm. Soon she was having 10 to 20 sleep attacks a day.

How to fix it Most narcoleptics have low levels of hypocretin, a neurochemical that keeps the brain alert. Treatment involves strict sleep schedules, to regulate the sleep cycle, and meds (usually stimulants). Xyrem, a nervous system depressant Baker takes, is the only FDA-approved drug that treats cataplexy. “It works,” she says. “I don’t fall over anymore.”